Strokectomy refers to the resection of infarct brain tissue. Used alone, in combination with decompressive hemicraniectomy (DHC), or as a remedial surgery to DHC for malignant cerebral infarction (MCI) patients, strokectomy has reduced mortality rates and improved functional outcomes of patients with MCI. However, the role of strokectomy in the treatment of MCI patients is controversial. The aim of this retrospective study was to investigate the efficacy of strokectomy in MCI treatment in order to explore its beneficial effects on improving patient outcomes.
This retrospective study was carried out between January 2017 and September 2019 in the First Affiliated Hospital of Jinan University and Guangdong 999 Brain Hospital in Guangzhou, China. We reviewed patients with MCI who underwent DHC with or without strokectomy. We collected and analyzed the following data for all patients: demographics, Glasgow Coma Scale scores (GCS), National Institutes of Health Stroke Scale (NIHSS) scores, observational data in the intensive care unit (ICU), post-surgery intracranial pressure (ICP) monitoring, midline shift before and after surgery, and functional outcomes measured with the modified Rankin Scale (mRS) at 6 months.
We recruited 95 patients (53 men; mean age, 59.71 ± 10.65 years; age range, 38 - 78 years). After surgery, patients who received DHC and strokectomy were associated with a lower ICP curve; decreased midline shift; and less mannitol, hypothermia, and hypertonic saline therapies than those who received DHC alone. No patient in the DHC+strokectomy group had malignant high ICP or needed remedial surgery; in contrast, 16 patients in the DHC group had malignant high ICP after DHC, and remedial surgery was recommended. Five patients received remedial surgery and survived, while the 11 who refused remedial surgery died. The mortality rate during ICU stay was 19.4% in the DHC group and 7.1% in the DHC+strokectomy group. While the rate of poor outcomes and mortality was significantly different between the two groups at 6 months after surgery, good outcomes did not differ significantly.
Strokectomy performed in combination with DHC can effectively decrease post-surgery ICP, reduce midline shift, and reduce mortality during the six months following surgery. Moreover, strokectomy performed as a remedial surgery could decrease malignant high ICP after DHC and reduce mortality.